Dealing with urinary incontinence

With a donation of HK$1.26 million from The Hong Kong Jockey Club Charities Trust under CADENZA: A Jockey Club Initiative for Seniors, Professor Claudia Lai, School of Nursing (SN) of The Hong Kong Polytechnic University (PolyU), who is also Jockey Club CADENZA Fellow, conducted an experimental study for 31 months on the effectiveness of "Prompted Voiding" (PV) as a behavioral strategy for urinary incontinence among elderly people. The results showed that PV is an effective measure for managing the problem of urinary incontinence. It is also a behavioral strategy that can be implemented in nursing homes, both to deal with the problem and to change the attitudes of elderly residents and caregivers towards urinary incontinence.

Urinary incontinence is a common health problem among the elderly. The elderly with this problem cannot control their urination at will and suffer from involuntary leakages of urine. Urinary incontinence does not only affect their everyday life, but also have a negative impact on their physical and psychological well-being. Although urinary incontinence is a very common problem, most elderly people refrain from talking about it and are afraid of being stereotyped, thus resulting in negligence of the issue.

According to a survey conducted by The University of Hong Kong in 2003, 10%-15% of those aged 65 and above in Hong Kong suffer from urinary incontinence. Among elderly residents of nursing homes, the occurrence of urinary incontinence has increased significantly over the past 20 years, from 23.3% in 1992 to 45% in 2003 and 54.1% in 2009. The most common way of managing urinary incontinence among elderly people is to use adult diapers, which however could affect their dignity and self-confidence. It also irritates their skin, leading to a greater chance that they will develop urinary tract infections. There are three behavioral strategies which can be used for managing urinary incontinence: timed voiding, bladder training, and prompted voiding. According to research conducted in other countries, prompted voiding is the most effective measure for managing urinary incontinence among the elderly, and can reduce their reliance on diapers.

PV is a non-invasive behavioral strategy. Caregivers will remind the elderly to go to the washroom regularly, so as to reduce the occurrence of incontinence and increase their awareness of bladder control. As the workflow of PV is simple and straightforward, frontline staff at nursing homes can easily work on it. While this cost-effective strategy is widely adopted in overseas nursing homes, no studies on PV have been conducted in Hong Kong. The research conducted by PolyU's School of Nursing is the first local study about the effectiveness of PV as a behavioral strategy to manage urinary incontinence.

Professor Lai and her research team conducted an experimental study on the effectiveness and sustainability of PV in managing urinary incontinence in the elderly between January 2011 and July 2013, involving residents from five local nursing homes. The researchers selected 52 elderly people who met the criteria for inclusion from 486 voluntary participants. The 52 participants were randomly assigned to an experimental group (PV therapy) and a control group (normal incontinence care). The results showed that the urinary incontinence rate among those with PV therapy dropped from 72.6% to 58.7%, while the rate for the control group rose from 66% to 77.6%. This indicates that PV is effective in reducing urinary incontinence in local nursing homes and that the effects are sustainable over time.

"When prompted by staff to regularly go to the washroom, the elderly went a long way towards managing their urinary incontinence problem and were able to enhance the quality of their life. Staff training and quality assurance are the keys to the success of the program. Staff at the participating nursing homes acknowledged the effectiveness of the PV strategy and regarded it as an alternative solution for managing urinary incontinence. The attitude of the staff towards urinary incontinence among the elderly also changed after the training," said Professor Lai. To ensure the continued success of the PV program, Professor Lai recommended that the nursing homes to appoint an officer-in-charge to develop a quality assurance, continuous surveillance and feedback system. "The results and data collected in this study will definitely help to increase the public's concern about urinary incontinence. To further promote the therapeutic value of a PV behavioral strategy, we have consolidated the findings and the key points into a practical manual under the sponsorship of The Hong Kong Jockey Club Charities Trust. Local social entities are welcome to request a copy for reference."

Jockey Club CADENZA Project Director Professor Jean Woo said that CADENZA: A Jockey Club Initiative for Seniors was initiated by The Hong Kong Jockey Club Charities Trust in view of the aging population. One of the key elements of the project is to cultivate and nurture academic leadership in gerontology. It is hoped that Jockey Club CADENZA Fellows of different disciplines can proactively consider the needs of the elderly in their research and teaching. Introducing Jockey Club CADENZA Fellow Professor Lai's PV study, Professor Woo said the research aimed to find out a suitable behavioral therapy to manage incontinence in order to reduce elderly people's reliance on diapers.

Caritas Fu Tung Home was one of the nursing homes that participated in the study. "As the PV program significantly improves the problem of urinary incontinence in our nursing home, our management has included this initiative as part of the care routines for the benefit of all residents," said Miss Lai Kit-yee, Officer of Caritas Fu Tung Home.